This project builds on existing collaborations between the University of Southern Maine (USM) and MaineHealth/Maine Medical Center (MMC), Maine's largest health system, to expand Maine's capacity to conduct research that contributes to improvements in the quality of chronic illness care. The project combines the resources and expertise of two nationally recognized research institutions, USM's Institute for Health Policy, and MMC's Center for Outcomes Research and Evaluation, and two provider-practitioner organizations, MaineHealth/MMC and USM's College of Nursing and Health Professions. The project aims are to create a Practice Improvement Research Center to develop and support collaboration among researchers from the participating institutions; develop tools and procedures to conduct practice-based health services research on quality improvement (Ql); develop the investigators' research skills to study practice-based Ql; and conduct a study of the characteristics of primary care practices that have successfully engaged in quality improvement activities for individuals with chronic illness. The infrastructure plan includes the development of administrative systems, research tools (e.g. databases), and data collection and use strategies and systems to support the Center's research. Extensive consultation from national experts will be used to build the investigators' knowledge and skills. The research project is a multi-method study of the organizational and other characteristics of practices that affect success in implementing Ql related to chronic illness. The study will involve 75 primary care practices involved in MaineHealth/MMC system-wide Ql initiatives to improve chronic illness care. Fifteen practices demonstrating varying levels of success in Ql ("good," "some," "not yet making progress") will be selected for in-depth study. Information on practice structure, process, culture, and Ql initiatives will be collected through questionnaires and semi-structured interviews with clinicians, clinical support staff, and administrators to identify characteristics associated with varying levels of success in implementing programs to improve chronic illness care. Little is known about why some primary care practices have been more successful than others in improving chronic illness care. Research is needed to identify the most successful approaches to Ql, make the most effective use of scarce resources for Ql, and share the lessons learned in Maine with the rest of the nation. [unreadable] [unreadable] [unreadable]